Referring Physician Information

Online Appointment Request
(801) 213-3599

The Department of Pediatrics is here to assist community physicians and specialists with consultation and referral services. To refer a patient, please complete the form below and fax all related clinic notes and diagnostic reports to the specialty fax number. If no fax or online referral form is listed you will need to call the division directly.

* Name:Office Contact:Department:Phone:Fax:* Email Address:Select One:Referring to:Urgency Rating:Would you like to request a specific provider?:Patient Name:University Health Care Medical Record Number (if known):Date of Birth (MM/DD/YYYY):Address:City:State:Zip Code:Secondary Phone:Policy Number:Policy Holder:Phone Number:Insurance Provider:Policy Number:Policy Holder:Phone Number:Insurance Provider:Enter Watermelon Here

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For clinic notes and diagnostic reports

Specialty	Fax
General Pediatrics
Pediatric Allergy, Immunology & Rheumatology	801-587-7539
Pediatric Behavioral Health
Pediatric Cancer
Pediatric Cardiology	801-587-7539
Pediatric Diabetes & Endocrinology	801-587-7539
Pediatric Gastroenterology	801-587-7539
Pediatric Infectious Disease	801-585-3789
Pediatric Medical Genetics/Metabolic	801-581-8986
Pediatric Nephrology & Hypertension	801-587-7539
Pediatric Neurology	801-587-7539
Pediatric Ophthalmology	801-581-3357
Pediatric Orthopaedics	801-581-4402
Pediatric ENT (Otolaryngology)	801-585-2500
Pediatric Physical Medicine & Rehabilitation/ Comprehensive Care	801-587-7539
Pediatric Plastic Surgery
Pediatric Pulmonary Care & Sleep Medicine	801-587-7539
Pediatric Surgery
Pediatric Urology

Pediatrics

Referring Physician Information

(801) 213-3599